Timing of mastectomy and the effect on the likelihood of outpatient surgery and cost savings in breast cancer patients

Background: Same -day discharge after mastectomy has potential patient- and hospital -level benefits; however, few data are available regarding factors affecting the likelihood of same -day discharge in order to address barriers. We sought to evaluate factors contributing to same -day discharge, focusing on the timing of mastectomy during the operative day. Methods: We conducted a single -institution retrospective review of patients who underwent mastectomies for malignancy over a 3-y time frame. Clinicopathologic variables were collected along with a binary variable for mastectomy start time (morning versus afternoon). Our primary endpoint was rate of same -day discharge. A multivariable logistic regression model was constructed from significant univariate variables to determine independent predictors of same -day discharge. A secondary endpoint was a cost -utility analysis for morning versus afternoon start time, using hospital cost data. Results: There were 451 patients included in the analysis. Factors associated with same -day discharge rate included the American Society of Anesthesiologists score, use of a preoperative regional anesthesia block, type of mastectomy performed, individual surgeon variation, and a morning start for the mastectomy. On multivariable analysis, morning start was a strong independent predictor of same -day discharge (odd ratio 1/4 2.83; 95% CI, 1.75-4.60). The cost -utility analysis favored a morning start, with average cost savings of $550 per patient. Conclusion: Despite patient- and surgeon -specific variations, simple scheduling policies can improve same -day discharge rates after mastectomy, leading to improved hospital bed use and cost reduction. (c) 2023 Elsevier Inc. All rights reserved.